Provider Demographics
NPI:1508359027
Name:ALFONSO, DIANNE (BCABA)
Entity Type:Individual
Prefix:MRS
First Name:DIANNE
Middle Name:
Last Name:ALFONSO
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:417 NW 1ST STREET
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33993-3226
Mailing Address - Country:US
Mailing Address - Phone:786-862-8178
Mailing Address - Fax:
Practice Address - Street 1:417 NW 1ST STREET
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33993-3226
Practice Address - Country:US
Practice Address - Phone:786-862-8178
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-09
Last Update Date:2023-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician